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PBGH Spotlight
Winter 2010


PBGH Supports Delivery System Reform

Pacific Business Group on Health organized a diverse group of employer, consumer and labor organizations to issue consensus recommendations to strengthen health reform legislation through payment redesign, comparative effectiveness research, performance measurement and public reporting. These recommendations seek to assure that any agreement between the Senate and the House keeps the strongest possible elements in these core areas for delivery reform.

The current fee-for-service payment model is not working, and changing payment to drive quality improvement and value must be central to any reform. Value-based purchasing, incentives for primary care and alignment between public and private payers are just some of the details that PBGH and others have successfully gotten into reform legislation – the challenge now is to keep them in a final bill. At the same time, PBGH continues to collaborate with the Center for Payment Reform to accelerate changes in how private payers reward better value instead of volume.

Reform must also advance comparative effectiveness research that supports more informed decision-making by consumers and providers in their choice of treatment. Infrastructure development is needed to advance quality improvement and accountability. Beyond "meaningful use" of health information technology, such a program needs to foster development and adoption of nationally standardized measures for quality outcomes, patient experience, care coordination and resource use.

California Cooperative Healthcare Reporting Initiative (CCHRI) Launches New Website and PPO Scorecard

For the first time, California consumers have access to PPO health plan performance information for HEDIS clinical quality measures and CAHPS member experience results alongside HMO data which have been reported for many years through the California Office of the Patient Advocate. The PPO Report Card will allow consumers to compare PPOs in a number of key areas such as diabetes care, preventive screenings and heart care.

“Consumers need the best possible information and transparency when choosing their health insurance provider,” said Department of Insurance Commissioner Steve Poizner, who called for public reporting of PPO performance in 2007. “This type of report on PPOs has never been done before, but California is setting the bar higher for everyone. The value to consumers is huge, but the benefits to the entire health care system are even greater. We now have a baseline, and every insurer knows their performance needs to get better every year. Consumers are watching.”

The release of the PPO results coincides with the redesign of the CCHRI Website to provide on-demand comparison reports with both California and national benchmarking data. The new tools support evaluation and assessment by purchasers, health plans and provider organizations. Consumer information is available at www.opa.ca.gov. In general, the health plans continue to make modest improvements in both quality and member experience. Member experience scores, such as the overall rating of the plan and claims processing, show the greatest variation among plans. In addition, the Physician Organization Patient Assessment Survey and After Hours survey results are available via a downloadable spreadsheet.

Leapfrog Group Names Top 2009 Hospitals

California led with 13 adult and pediatric hospitals named to the Leapfrog 2009 Top Hospitals list. The voluntary Leapfrog Group survey is the only national, public comparison of hospitals on key issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency. These hospitals were selected based on their performance on the 2009 Leapfrog Hospital Survey and for achieving Leapfrog’s hospital quality and efficiency standards:

  • Implementing computer physician order entry (CPOE) systems that help prevent medication errors, and testing these systems with Leapfrog’s CPOE Evaluation Tool;
  • Meeting stringent performance standards for at least half of the complex, high-risk procedures (such as heart bypass surgery) done in these hospitals;
  • Meeting the Intensive Care Unit staffing standard; and
  • Scoring in the top decile for value and efficiency as measured by the hospitals’ scores for quality and resource use in caring for heart bypass surgery, heart angioplasty, heart attack and pneumonia patients.

Additional quality measures for California hospitals are available through the voluntary California Hospital Assessment Reporting Taskforce (CHART) website, www.calhospitalcompare.org. Qualifying for Leapfrog's 2009 Top Hospital Award includes one new criterion: once hospitals demonstrate top quality, they must also excel on efficiency. The hospitals are:

  • California Pacific Medical Center - Davies Campus, San Francisco
  • California Pacific Medical Center - California Campus; San Francisco
  • California Pacific Medical Center - Pacific Campus; San Francisco
  • Kaiser Permanente Anaheim Medical Center, Anaheim
  • Kaiser Permanente Baldwin Park Medical Center, Baldwin Park
  • Kaiser Permanente Bellflower/Downey Medical Center, Bellflower
  • Kaiser Permanente Hayward Hospital, Hayward
  • Kaiser Permanente Sacramento Hospital, Sacramento
  • Kaiser Permanente South Sacramento Hospital, Sacramento
  • Stanford Hospital and Clinics, Stanford
  • University of California Davis Medical Center; Sacramento

Top California pediatric hospitals in 2009 are:

  • Childrens Hospital Los Angeles
  • Children's Hospital of Orange County

The Leapfrog Group uses the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Hospitals that participate in The Leapfrog Hospital Survey achieve hospital-wide improvements that save lives and dollars. Leapfrog's purchaser members use survey results to inform their employees and purchasing strategies. In the past year, 1,206 hospitals across the country completed The Leapfrog Hospital Survey.

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PBGH in the Spotlight

Peter V. Lee, PBGH Executive Director for National Health Policy, with John Tooker, MD, CEO of the American College of Physicians and Robert Berenson, MD, national health policy expert, co-authored Payment Reform: The Need to Harmonize Approaches in Medicare and the Private Sector in the New England Journal of Medicine.

Arnie Milstein, MD, MPH, PBGH Medical Director co-authored a Health Affairs blog, Are Higher Value Care Models Replicable?

David Lansky, PhD, PBGH CEO, has been named Chair of the Nationwide Health Information Network (NHIN) Workgroup of the National HIT Policy Committee.

David Lansky, PhD and Arnold Milstein MD, MPH co-authored Quality Measurement in Orthopaedics: The Purchasers View in Clinical Orthopaedics and Related Research, which calls for voluntary development of a uniform national registry for joint replacements that includes capture of pre-operative appropriateness indicators, device monitoring information, revision rates and clinical outcomes.

California Quality Collaborative (CQC) has received the inaugural Right Care Innovators Award from the California Department of Managed Health Care (DMHC) for its work with provider groups to improve patient outcomes. The Inland Quality Collaborative, started in April 2007, brings together Southern California physician groups, public clinics and hospitals, health plans and community agencies to share best practices. Quarterly meetings focus on patient self-management support, patient tracking systems and service protocols to make sure residents receive all recommended care for their diabetes or their heart condition. Read press release. More: 2009 Accomplishments



PBGH Member Highlights

PBGH welcomes The Walt Disney Company as a new Member. Founded in 1923, Disney is a diversified international family entertainment and media enterprise with four business segments: media networks, parks and resorts, studio entertainment and consumer products.

Safeway Inc. was recognized by the National Business Coalition on Health (NBCH) with the Employer Excellence in Value-Based Purchasing Award for its leadership and efforts to improve the quality and efficiency of the health care delivery system, control health care expenditures at the community level and improve the health of employees. Safeway Inc., one of the largest food and drug retailers in North America, is a leader in the health care reform debate, calling for information transparency that supports personal responsibility, market efficiency and delivery system re-engineering.




About PBGH

Pacific Business Group on Health is one of the nation's top business coalitions focused on health care.  Our 50 large purchaser members spend billions of dollars annually to provide health care coverage to more than 3 million employees, retirees and dependents.  PBGH is a respected voice in the state and national dialogue on how to improve the quality and effectiveness of health care while moderating costs.  Partnering with the state's leading health plans, provider organizations, consumer groups and other stakeholders, PBGH works on many fronts to promote value-based purchasing in health care.